Clinical Application of the Bulgarian Version of the SCCAN: Pilot Data From Patients with Alzheimer’s Disease and Ischemic Stroke

Total views: 1159 | Open access Open Access

Authors

https://doi.org/10.33700/jhrs.4.1.149

Keywords:

SCCAN, cognitive-communicative disorders, Alzheimer’s disease, ischemic stroke, neurorehabilitation, screening

Abstract

Abstract

Aim: This study evaluated the clinical utility of the Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN) upon assessing Bulgarian in-patients who present with either ischemic stroke or Alzheimer's disease (AD). The aim was to determine whether this tool could detect cognitive-communicative problems that may be missed by customary screening tools.

Methods: We conducted two independent pilot studies: one with 14 AD patients, and a second with 19 stroke patients and 31 healthy controls. All participants completed the Bulgarian SCCAN, which assesses eight domains including oral expression, orientation, memory, auditory and reading comprehension, writing, attention, and problem-solving. Stroke and control participants also underwent the Mini-Mental State Examination (MMSE). Descriptive statistics were used so group performance and correlations could be examined. Tests that are non-parametric were also used.

Results: SCCAN revealed domain-specific deficits in clinical cohorts. In the AD group, memory and orientation were the most impaired domains. Stroke patients, on the other hand, showed significant impairments, particularly in memory, oral expression, and auditory comprehension, while orientation and attention were relatively preserved. Overall, stroke patients performed significantly better on the SCCAN than the AD group. These findings reveal distinct cognitive–communicative profiles in AD versus stroke populations.

Conclusion: SCCAN's Bulgarian version identified cognitive-communicative deficits with clinical sensitivity in patients with AD as well as with those with ischemic stroke. The tool may guide individualized neurorehabilitation and complement standard screening methods. Additional verification is advised.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Bayles, K. A., McCullough, K. C., & Tomoeda, C. K. (2020). Cognitive-communication disorders of MCI and dementia: Definition, assessment, and clinical management (3rd ed.). Plural Publishing Inc.

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91. doi: 10.1097/00007632-200012150-00014. PMID: 11124735.

Braak, H., & Braak, E. (1991). Neuropathological stageing of Alzheimer-related changes. Acta Neuropathologica, 82(4), 239–259. https://doi.org/10.1007/BF00308809

Bulgarian Dementia Society. (2015). National consensus for early diagnosis and treatment of Alzheimer’s disease and other forms of dementia. Sofia: Bulgarian Dementia Society.

Cumming, T. B., Marshall, R. S., & Lazar, R. M. (2013). Stroke, cognitive deficits, and rehabilitation: Still an incomplete picture. International Journal of Stroke, 8(1), 38–45. https://doi.org/10.1111/j.1747-4949.2012.00972.x

Hillis, A. E., & Heidler, J. (2002). Mechanisms of early aphasia recovery. Aphasiology, 16(9), 885–895. https://doi.org/10.1080/0268703

Jack, C. R. Jr., Bennett, D. A., Blennow, K., Carrillo, M. C., Dunn, B., Haeberlein, S. B., ... & Sperling, R. (2018). NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimer’s & Dementia, 14(4), 535–562. https://doi.org/10.1016/j.jalz.2018.02.018

Jack, C. R. Jr., Knopman, D. S., Jagust, W. J., Petersen, R. C., Weiner, M. W., Aisen, P. S., ... & Trojanowski, J. Q. (2013). Tracking pathophysiological processes in Alzheimer's disease: An updated hypothetical model of dynamic biomarkers. Lancet Neurology, 12(2), 207–216. https://doi.org/10.1016/S1474-4422(12)70291-0

Jaya, V., Rani, R. J., & Monish, V. (2017). Cognitive communicative deficits in adults with stroke. Indian Journal of Neurosciences, 3(2), 61–64. https://doi.org/10.18231/2455-8451.2017.0015

Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). Oxford University Press.

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6

McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R. Jr., Kawas, C. H., ... & Phelps, C. H. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups. Alzheimer’s & Dementia, 7(3), 263–269. https://doi.org/10.1016/j.jalz.2011.03.005

Milman, L. H., Holland, A. L., Kaszniak, A. W., D’Agostino, J. A., Garrett, M. F., & Rapcsak, S. Z. (2008). Initial validity and reliability of the SCCAN: Using tailored testing to assess adult cognition and communication. Journal of Speech, Language, and Hearing Research, 51(1), 49–69. https://doi.org/10.1044/1092-4388(2008/004)

Milman, L. H., & Holland, A. L. (2012). Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN) (Examiner’s Manual). Austin, TX: PRO-ED.

Milman, L. H., & Missel, A. (2020, March). The Scales of Cognitive and Communicative Ability for NeuroRehabilitation (SCCAN): Psychometric properties & administration across the continuum of care [Conference presentation]. United States Speech-Language-Hearing Association (USHA). https://www.ushaonline.net/wp-content/uploads/2020/03/2020USHAhoMilmanMisselslides.pdf

Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

Raycheva, M., Stoyanova, K., Dzhanyan, A., Mehrabian, Sh., Pavlova, R., Petrova, M., & Traykov, L. (2013). Validation of the Bulgarian versions of the MMSE and Isaac Set Test for screening cognitive disorders in adults. Psychological Research, 16(1), 103–114.

Taler, V., & Phillips, N. A. (2008). Language performance in Alzheimer's disease and mild cognitive impairment: A comparative review. Journal of Clinical and Experimental Neuropsychology, 30(5), 501–556. https://doi.org/10.1080/13803390701550128

Togher, L., McDonald, S., & Code, C. (2014). Social and communication disorders following trau¬matic brain injury. In S. McDonald, L. Togher, & C. Code (Eds.), Social and communication disorders following traumatic brain injury (2nd ed., pp. 1–25). Psychology Press.

Tombaugh, T. N., & McIntyre, N. J. (1992). The Mini-Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922–935. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x

Turunen, K. E. A., Laari, S. P. K., et al. (2016). Executive impairment is associated with impaired memory performance in working-aged stroke patients. Journal of the International Neuropsychological Society, 22(5), 551–560. https://doi.org/10.1017/S1355617716000205

Verma, M., & Howard, R. J. (2012). Semantic memory and language dysfunction in early Alzheimer's disease: A review. International Journal of Geriatric Psychiatry, 27(12), 1209–1217. https://doi.org/10.1002/gps.3766

World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053

Published

13.07.2025 — Ahead of print updated on 03.08.2025 as final version

Versions

How to Cite

Chompalov, K., Atanassova, P., & Georgieva, D. (2025). Clinical Application of the Bulgarian Version of the SCCAN: Pilot Data From Patients with Alzheimer’s Disease and Ischemic Stroke. Journal of Health and Rehabilitation Sciences, 4(1), 39–47. https://doi.org/10.33700/jhrs.4.1.149 (Original work published July 13, 2025)

Issue

Section

Health Research

Citations

Metrics